Release of Iliopsoas tendon

Pain & Rehab Forum [Moderated]
1

Hey guys,

Not sure if this goes here or in Rehab section. About a year ago, my wife had a total replacement of her right hip (Apr '18). Shortly after surgery (posterior, not anterior), she complained of a tightness in her upper thigh; shooting pain into her groin; pain climbing stairs or getting into / out of a car; and a noticeable limp. She underwent PT for around 6-8wks, but it didn’t help with the symptoms. Doc saw her 3 mos post surgery; told her she didn’t have a leg length discrepancy and said it should be healed within a year.

She just finished another 4wks of PT; doing most of the same exercises her original therapist had her do, again, with no improvement. Finally saw another ortho doc who stated she has an impingement of her iliopsoas. She has to go through some tests before he meets with us again. In the meantime, most of what I’ve found on PubMed says that this condition is usually caused by an anterior tilt of the acetabular ‘cup’. Apparently, this can be fixed one of two ways…fix the cup (differing methods) and/or “release” the tendon. This means cutting it, right?

My question is then what is the quality of life if the iliopsoas is cut? I get that she won’t be in pain anymore and movement will be restored…but can she still lift? It sounds like nothing good can come from cutting an important hip flexor. Any info regarding a projected outcome is greatly appreciated!

Thank you for all you do!!!

2

Hey ghostrider, I’m sorry to hear about your wife going through this. Could you elaborate on what your wife was doing during her time in physical therapy. Iliopsoas impingement in NO WAY requires surgical intervention. If she underwent a total hip replacement there is still a likelihood of some strength deficits that can be addressed with simple training interventions. Iliopsoas “release” can mean a surgical intervention or a form of manual therapy, neither of which have any good evidence for their effectiveness in treating anterior hip pain.

To your exact question at the end, it is the same as before it was cut. For a while, this was common practice in hip arthroscopy in order to access the joint. I haven’t looked at the updated literature on the procedure, but I know it was going out of vogue 5-6 years ago. If you give us some more information on what she has been doing in physical therapy we can likely offer some better advice.